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One of the things that's really um irritating is basic signs of imaging. And I'll teach you a little bit about image modalities of young adult with hip pain and what all these alpha angles, lateral central edge angles mean. Um It is an hour long. So we have questions and polls just to break it up. Um And if you have any questions just stop me, I won't bite. Um Thank you for those who have signed up. So Jos has signed up for one paper. There's still three, if not, if not two more papers to discuss the format will be on the 20th of February. We'll allocate about half an hour for a mini journal club with AP O format for five minutes. We'll talk about fate. Um The five year follow up for f uh You've, you've um you've heard from Mr Kua about the one of the randomized controlled trials. They have a five year follow up. Now, we'll talk about intraarticular hip injections for specifically for FA I cos that's really an important way of working these patients up. Uh There is a letter to editor that Mr Candu quoted, which is the one of the largest um referral center patients over 34 months on using diagnostic hip injections to rule out intraarticular versus extraarticular hip pain. Um and the le trial which is education plus exercise versus corticosteroids versus wait and see approach for patients with gluteal tendinopathy. So we get a lot of these patients right, lateral sided hip pain, a bit of ITB irritation and then you say b gluteal bursitis injection. Bye bye, which is not the correct way of doing things. If you participate in this journal club, um, imaging is important. This is from the curriculum. So you need radiological investigation to assess the hip fours, level fours. You need imaging in terms of X ray ct MRI ultrasound radioisotopes. And the way I'm gonna divide it is I will talk about the basic signs, boring bits then, um then we'll talk about the young adult hip stuff er, in the actual exam. Um This is plucked from my feedback. Er, it's divided into 456 and seven and eight. So this is the JCI E form in your basic science. They want to know 50% is basic knowledge and 50% is higher order thinking. So y everyone always starts off as a six cos they want to pass you. If you say something very controversial, you drop or you, if you say something really good, you go up. It's very rare that you get an eight or a four but people do if you, if you really impressed the examiner, there's always a setting setting scene, the ne next question and then a higher order thinking question. So, so for example, this can be a setting scene. So if anyone would like to be recorded and vivid on the spot, please uh volunteer. OK. I can only see two people on my screen. So I 42 people on my screen. Good go and just um so yeah, so, so was that a question? Yes, this is your vi table for basically? Wow. OK. One second. Mm. Um You've been given these two reports uh of the patient. What do you think the kind of imaging modality is? And how do you interpret this report? Um Put me on a spot um Obviously if things are being recorded. No, that's fine. I mean, I but I have to be honest, I don't know what I'm looking at it. I don't know it's x-rays and but what kind of x rays fluoroscopy? Perfect. So this is a fluoroscopic report. Anything else that you would like to comment on? So the radia, I mean it's radiation time, I think it's intraoperative. This is what this is the kind of picture we get when we have intra operative imaging, isn't it? So, yeah. Yeah. Is it something recorded? I mean if it maybe since it's uh you something from a hip arthroscopy perspective and you're trying to inject something. So if you work in Norwich, every fluo you, if once you do the trauma meeting, every time you always get this first picture and everyone just skips it. So, um so obviously you get a number of pictures you've taken, the more the ba the more the better it is uh radiation time. So total fluoroscopy time. So if you're live screening, that's bad, you're doing dose uh area product. So basically this is a combination of area plus dose. So sometimes you have collimation. So if the uh um you know how the radiographer sometimes says collimate and that some, in reality irritates some surgeons, but that's to reduce the dose because it depends on the area. Um and the K VMA uh and x-ray is all about the the amount of beams, the amount of radiation that the patient has uh has been given to that patient. So it will give individual fluoro fluoroscopic pictures. So you will see like a whole long list. So obviously, if you've had a very big um a a lot of pictures taken, you will see a lot of these individual lines of rolls of individual pictures. So x-ray is very important because we know that radiation protection and we use a lot of it if you were to art in a visor setting. This is the summary for Ramachandran. And if you don't want to ever read Ramachandran, this is the summary. So it's a high energy electromagnetic radiation that has a shorter wavelength than light. So if you ever get given an X ray picture in the, in the basic science table, you define x-ray as a high energy radiation, shorter wavelength than light, you heat the negative side of, of tungsten to incandescent in a vacuum chamber to a particular degree, you don't have to memorize the degrees. Some people think that they do for basic signs and the electrons get attracted to the positive side and then the negatively charged electrons leave um and some it gets out of the X ray tube and that comes out as your X ray and it goes towards the image intensifier as and mo normally this takes about 30 seconds for the definition and then you have to move on to say we have to obey with Eimer and Arla. So as low as possible um where we protect patients, uh the employer has the framework. The uh the Referrer is me, the practitioner is the radiographer and the operation sometimes is us sometimes is the radiographer. So the average or orthopedic surgeon will get about 200 chest X rays if you don't protect yourself properly, that includes eyes, thyroid, gland, thyroid guards and chest X ray. And in the exam, you obviously want to come out with a cartoon that's really quick. If you wanted to draw how an X tube will look like, you don't have to draw elaborate pictures. There's a negative side, there's a positive side, there's a tungsten that's heated up uh to incandescent. That means that a metal that shines is incandescent. Um It gets attracted to the positive side, there's electrons that escape. It's about 1% of all electrons that come out. Um Obviously, it's important as you because you're the one who uses a lot of x-rays, the milli amps per second. It i it the higher it is, it improves clarity but also increases radiation. So doses. So if you ever tell a a radiographer during philosopy, can you make that clearer? You're actually increasing the radiation dose, there can also increase the kilovolts for penetration. So for example, um metalwork, you get, you get high contrast images but you increase the energy beam. Uh So that's why we think about uh metal reduction artifacts and all that kind of stuff er the gamma Y is the absorb or um I is the absorbed radiation dose and obviously it comes up with a dose uh area product. Um The scattering collimation is one thing that I can never understand unless you take it into context. So I'm gonna go into context first before we talk about this. So in this picture when you're doing a fluoroscopy, um So for example, in the viva table, they will say how do you reduce radiation dose to protect yourself the patient and the other people in the uh operating theater. So in theory, you should say I'll bring the patient up closer to the imaging intensifier. Um the rate the x-ray, x-ray source should be from the bottom up so that it reduces scatter all around the room. So if you imagine the triangle being the other way around your scatter goes all over the room, whereas this scatter is go, it goes below the table. OK. So in, in a, in a Viber table, you obviously sometimes which I've heard before, this is a past your question, they give you a fluoroscopy machine and then you have to label it in a way. So you will say this is the X ray tube, this is the image intensifier. This, this is the um live screen that I can see. And obviously this is the base to moving the patient around and all. And of course, um it's a hot topic nowadays in the sense that um we, we are at risk in theater, including everyone else such as the scrub team and the way you reduce exposure, there's a lot of bway papers out there. So I won't bore you with that. But to reduce exposure includes um A l properly surveillance lead down. Um For um for women, you obviously want axillar protection.